Acquired Brain Injuries Flashcards
what is an acquired brain injury
any condition/event resulting in a sudden non-progressive, or non-degenerative change in neurological processing which can indicate
what are 4 categories of acquired brain injuries
traumatic brain injury, stroke or cerebral vascular accident, post surgical neurological complications and vestibular dysfunctions
what is vision rehabilitation
rehab of the entire visual system and focus on how visual processing impacts behavior and cognitive function
what does an optometrist do for brain injury patients
corrects refractive errors, assesses functional vision, and diagnoses ocular health issues
what are treatments that optometrists can do for brain injuries
lenses, prisms (fresnel, gottlieb, peli), low vision aids and visual rehabilitation
how do you place a prism on specs for a brain injury
base out on the eye of the side with the defect - superior or inferior not in center
where would you place a prism for a right hemianopsia
base out on the right lens
what things do you do differently in the exam for a brain injury
minimize movement around patient, keep room dim, speak clearly, take extensive case history, and notice orientation to person, place, time
what specific things are you going to ask a patient with a brain injury
diplopia, photophobia, headaches, VF cuts, balance and short/long term goals regarding specific vision symptoms
what do you pay special attention to during the work up
VF assessment - midline shift and neurological screening
what is visual neglect
cognitive deficit that refers to the unawareness of objects, people and visual stimuli presented in a visual space contralateral to the cerebral lesion
if a patient had a stroke to the right hemisphere, where would the neglect be
left visual spatial neglect
how is visual neglect different from VF cut
the patient with a VF cut is aware of their vision loss
what are some symptoms of visual neglect
alteration of egocenter (midline shift), bump into objects, skip words while reading, only eat half food on plate, lost in familiar/unfamiliar places, and groom half their face/hair
what are 2 tests for visual neglect
have patient draw a clock face and a specific time that incorporates both side of face - 9:15 or have patient do a line bisection (bisect center of each line)
what is a visual midline shift
mismatch of information and distorting of space due to disruption of ambient system
what are some symptoms of a visual midline shift
alteration of posture, difficulty with balance, hemiplegia, hemiparesis, flexion/extension difficulty, and neglect
how can you help treat visual midline shifts
yoked prisms
what is photophobia
extreme sensitivity to light- inducing pain
how can you treat photophobia
apply tints to lenses
what color tints are for outdoor and indoors
outdoors = brown/gray and indoors = blue or gray (blue is for fluorescent lights)
how can you help treat diplopia
can resolve on its own or use fresnel or ground in prisms
what exercises can help with oculomotor deficits
basic scanning and searching exercises: line tracing (Ann Arbor/Michigan tracking), track words while listening to book on tape, call out first and last letter on a page and create an aperture/window highlighting the text (concentrate on accuracy and speed later)
how can you help with vergence deficits
stabilize vergence in primary gaze at far and near distance and facility and sustainability of fusional vergence at far and near viewing distances
how can you help with accommodation deficits
work on improving the weaker aspect of focusing, build up and equalize accommodative amplitudes, and work on maintaining ability to rapidly change focus on command and sustain focus for extended periods of time
what exercises can help with accommodation deficits
loose lenses/flipper - use different targets at different distances
how can you help with visual-vestibular deficits
work on central- peripheral integration
how can you help impaired visual field integrity
practice scanning into the blind field, teach patient to look into their blind zone and Borderzone stimulation
what instrument is used for borderzone stimulation
Nova Vision Therapy System - maps edge of field and presents stimuli near border making small increases
how many areas of the brain are involved in visual processing
35
what deficits occur with oculomotor dysfunction
limitations of gaze, nystagmus, and speed and quality of pursuits and saccades
what are some potential symptoms of oculomotor dysfunction
inability to follow objects smoothly, reading problems, skipping words, re-reading words, and word/letter reversals
what are some deficits with binocular dysfunction
strabismus, muscle paresis/paralysis, convergence insufficiency, and reduced or slow fusional ability
what are some potential symptoms of binocular dysfunction
head turn/tilt, diplopia, poor depth/spacial judgements, closing one eye, headaches, asthenopia, reading difficulty, tired eyes, watering, fall asleep while reading, and task avoidance
what are some deficits with accommodative dysfunction
accommodative insufficiency, pseudo-myopia, and speed and quality of accommodative response
what are some potential symptoms of accommodative dysfunction
blue, headaches, pain, diplopia, squinting, closing one eye, reading problems, ocular discomfort, tired/watery eyes, falling asleep while reading and task avoidance
what are some deficits with visual-spatial/visual information processing dysfunction
visual-vestibular integration problems, visual-motor integration problems, difficulty understanding spacial coordination, disturbances in body image, disturbance in sustaining visual attention
what are some symptoms with visual-spatial/visual information processing dysfunction
balance issues, poor distance judgement, motor coordination problems, eye-hand problems, left/right confusion, objects appear to move, agnoisa, apraxia, inattentive, recognizing faces, visual memory and writing difficulty
what are some symptoms for VF loss/visual-spatial neglect
oculomotor related symptoms, difficulty locating objects, gait, balance, seeing at night, spatial insecurity, unable to drive
what VF loss occurs with a lesion anterior to optic chiasm
monocular visual field loss
what VF loss occurs with a lesion or tumor at the optic chiasm
bitemporal hemianopsia
